Provider Demographics
NPI:1114510195
Name:MARTINEZ SANTOS, SARA E (LCDA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:MARTINEZ SANTOS
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:MARTINEZ SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SARA MARTINEZ, PSIC
Mailing Address - Street 1:AJ13 CALLE 57
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4231
Mailing Address - Country:US
Mailing Address - Phone:787-948-2099
Mailing Address - Fax:
Practice Address - Street 1:22 46 AVE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-510-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist